NEET-PG 2023 - Pediatrics PYQs Practice Questions

Q: A 4-year-old child is brought to the emergency department with severe dehydration due to diarrhea. What is the initial management for severe dehydration?

Intravenous fluids. ***Intravenous fluids*** - For **severe dehydration**, rapid correction of fluid and electrolyte imbalances is critical, and **intravenous fluids** (normal saline or Ringer's lactate) are the **first-line treatment**. - As per **WHO and IAP guidelines**, children with severe dehydration require **IV fluid resuscitation** at 100 mL/kg over 3-6 hours (or 30 mL/kg bolus initially). - Signs of severe dehydration include **lethargy, sunken eyes, absent tears, very dry mucous membranes, poor skin turgor**, and inability to drink. - IV route ensures **rapid intravascular volume expansion** when oral intake is compromised or inadequate. *Oral rehydration therapy* - **ORT** is the treatment of choice for **mild to moderate dehydration only** (Plan B as per WHO). - In severe dehydration, children often have **altered consciousness, persistent vomiting**, or **circulatory compromise**, making oral intake ineffective or impossible. - ORT can be initiated once the child is alert and able to drink after initial IV resuscitation. *Antidiarrheal medication* - **Not recommended** in children with acute diarrhea, especially under 5 years. - Medications like loperamide can cause **ileus, drowsiness**, and may worsen outcomes. - They do **not address fluid and electrolyte deficits**, which is the immediate life-threatening concern. *Antibiotics* - Only indicated for **specific bacterial causes** (e.g., cholera, shigellosis with blood in stool, or proven invasive bacterial infection). - **Not part of initial management** for severe dehydration. - Indiscriminate use contributes to **antibiotic resistance** and delays critical rehydration. [Practice more Pediatrics PYQs on OnCourse]

Q: The 7-year-old boy, who is now in your office, was last seen 2 weeks ago with a mild viral upper respiratory tract infection. However, he presents today with fever, ataxia, weakness, headache, and vomiting. In the office, he experiences a 3-minute left-sided tonic-clonic seizure. After sending him to the hospital and ordering a magnetic resonance imaging (MRI) with contrast of the brain, the results of which are shown, his likely diagnosis is which of the following?

Acute disseminated encephalomyelitis (ADEM). ***Acute disseminated encephalomyelitis (ADEM)*** - This condition typically presents with **acute neurological deficits** (ataxia, weakness, seizures) following a **viral illness** (URI 2 weeks prior) in children. - MRI findings in ADEM often show **widespread, inflammatory, demyelinating lesions**, consistent with the described image in the context of post-infectious neurological symptoms. *Malignant astrocytoma* - While it can cause neurological deficits and seizures, a malignant astrocytoma would typically manifest as a **single, discrete mass lesion** on MRI with significant mass effect. - The rapid onset of widespread symptoms after a viral illness is less characteristic of a primary brain tumor. *Bacterial meningitis* - This would present with more prominent signs of infection such as **high-grade fever**, nuchal rigidity, and altered mental status, and the MRI would likely show **leptomeningeal enhancement** or hydrocephalus, not widespread demyelinating lesions. - The antecedent viral illness and specific neurological symptom profile are more suggestive of a post-infectious demyelinating process. *Multiple sclerosis (MS)* - While MS is a demyelinating disease, it is far **less common in a 7-year-old child** with such an acute presentation following a viral infection. - MS typically has a **relapsing-remitting course** with lesions evolving over time, and usually presents in young adults. [Practice more Pediatrics PYQs on OnCourse]

Q: What is the most common cause of conjugated hyperbilirubinemia in infants?

Biliary atresia. ***Rotor syndrome*** - Characterized by **conjugated hyperbilirubinemia** due to a defect in hepatic uptake and storage of bilirubin [1]. - This condition can lead to elevated levels of **direct (conjugated) bilirubin** without significant liver damage. *Crigler Najjar* - This condition primarily causes **unconjugated hyperbilirubinemia** due to a deficiency of the enzyme **uridine diphosphate glucuronyl transferase** [1]. - It typically presents with **kernicterus** in newborns rather than conjugated bilirubin elevation. *Breast milk jaundice* - Mainly leads to **unconjugated hyperbilirubinemia** due to substances in breast milk that inhibit bilirubin conjugation. - Generally occurs in **breastfed infants** after the first week of life, not presenting with increased conjugated bilirubin. *Gilbert syndrome* - This syndrome is associated with **unconjugated hyperbilirubinemia** due to a genetic defect in bilirubin conjugation [1]. - Typically benign, it does not cause **increased conjugated bilirubin** levels as seen in Rotor syndrome. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Liver and Gallbladder, p. 860. [Practice more Pediatrics PYQs on OnCourse]

Q: Which of the following is the best sign to indicate adequate growth in an infant with a birth weight of 2.8 kg?

Increase in length of 25 centimetres in the first year. ***Increase in length of 25 centimetres in the first year*** - A **25 cm increase in length during the first year** is a normal and expected growth rate for infants, indicating adequate overall growth and development since overall length growth is a sensitive indicator of good health. - This corresponds to roughly a **50% increase in birth length** (which is typically around 50 cm), demonstrating appropriate linear growth. *Weight gain of 300 grams per month till 1 year* - While weight gain is crucial, an infant typically **gains more than 300 grams per month** in the early months (e.g., 500-1000g/month for the first 3-4 months) and then the rate slows. - This value represents an **average over the entire year** and may not reflect adequate growth during periods of rapid weight gain. *Anterior fontanelle closure by 6 months of age* - The **anterior fontanelle typically closes between 10 to 18 months of age**, with closure as early as 6 months being within the normal range but not the *best* indicator of overall growth. - While fontanelle closure is an important developmental milestone, it is **not a direct measure of growth in length or weight**, which are more indicative of nutritional status. *Weight under the 75th percentile and height under the 25th percentile* - Having weight under the 75th percentile and height under the 25th percentile means the **child is growing disproportionately**, which could suggest a growth problem or underlying health issue. - **Optimal growth** is typically indicated when weight and height measurements fall within a similar percentile range, generally between the 25th and 75th percentiles. [Practice more Pediatrics PYQs on OnCourse]

Q: A 3-month-old baby presents with deafness, cataract, and patent ductus arteriosus. Which of the following is the most likely diagnosis?

Congenital rubella syndrome. ***Congenital rubella syndrome*** - The classic triad of **deafness**, **cataracts**, and **patent ductus arteriosus (PDA)** is highly characteristic of congenital rubella syndrome. - This syndrome results from **maternal rubella infection** during the first trimester of pregnancy. *Congenital herpes simplex virus infection* - Typically presents with **skin vesicles**, **keratoconjunctivitis**, and **encephalitis**. - **Deafness, cataracts, and PDA** are not common features of congenital HSV. *Congenital toxoplasmosis* - The classic triad involves **chorioretinitis**, **hydrocephalus**, and **intracranial calcifications**. - While it can cause microcephaly and seizures, **deafness, cataracts, and PDA** are not hallmark features. *Congenital cytomegalovirus infection* - Often causes **sensorineural hearing loss** and sometimes **chorioretinitis**, but the combination with **cataracts** and **PDA** is atypical. - Other common features include **periventricular calcifications**, **hepatosplenomegaly**, and **thrombocytopenia**. [Practice more Pediatrics PYQs on OnCourse]

Question 1

A 4-year-old child is brought to the emergency department with severe dehydration due to diarrhea. What is the initial management for severe dehydration?

Accepted Answer

Intravenous fluids

Answer

Oral rehydration therapy

Answer

Antidiarrheal medication

Answer

Antibiotics

Question 2

The 7-year-old boy, who is now in your office, was last seen 2 weeks ago with a mild viral upper respiratory tract infection. However, he presents today with fever, ataxia, weakness, headache, and vomiting. In the office, he experiences a 3-minute left-sided tonic-clonic seizure. After sending him to the hospital and ordering a magnetic resonance imaging (MRI) with contrast of the brain, the results of which are shown, his likely diagnosis is which of the following?

Accepted Answer

Acute disseminated encephalomyelitis (ADEM)

Answer

Malignant astrocytoma

Answer

Bacterial meningitis

Answer

Multiple sclerosis (MS)

Question 3

What is the most common cause of conjugated hyperbilirubinemia in infants?

Accepted Answer

Biliary atresia

Answer

Rotor syndrome

Answer

Crigler Najjar syndrome

Answer

Dubin-Johnson syndrome

Question 4

Which of the following is the best sign to indicate adequate growth in an infant with a birth weight of 2.8 kg?

Accepted Answer

Increase in length of 25 centimetres in the first year

Answer

Weight gain of 300 grams per month till 1 year

Answer

Anterior fontanelle closure by 6 months of age

Answer

Weight under the 75th percentile and height under the 25th percentile

Question 5

A 3-month-old baby presents with deafness, cataract, and patent ductus arteriosus. Which of the following is the most likely diagnosis?

Accepted Answer

Congenital rubella syndrome

Answer

Congenital herpes simplex virus infection

Answer

Congenital toxoplasmosis

Answer

Congenital cytomegalovirus infection

Question 6

A child was brought with pedal edema and cheilosis. Cardiomegaly was present. What is the vitamin deficiency associated with this clinical presentation?

Accepted Answer

Thiamine deficiency

Answer

Riboflavin deficiency

Answer

Pyridoxine deficiency

Answer

Niacin deficiency

Question 7

An infant presents with hepatosplenomegaly and thrombocytopenia. Neuroimaging with CT    shows periventricular calcifications. What is the most likely diagnosis?

Accepted Answer

Congenital cytomegalovirus infection

Answer

Congenital rubella syndrome

Answer

Congenital herpes simplex virus infection

Answer

Congenital toxoplasmosis

Question 8

A 2-year-old child with a history of eczema presents with a red, scaly rash around the mouth and extremities. A dietary history reveals excessive consumption of cow's milk. What nutritional deficiency is most likely?

Accepted Answer

Zinc deficiency

Answer

Iron deficiency

Answer

Vitamin D deficiency

Answer

Vitamin C deficiency

Question 9

A 2 year child presented with low grade fever and stridor. What is the likely diagnosis?

Accepted Answer

Acute Laryngotracheobronchitis

Answer

Acute Bacterial Tracheitis

Answer

Acute Epiglottitis

Answer

Foreign Body aspiration

Question 10

Koplik spots are seen in?

Accepted Answer

Measles

Answer

Rubella

Answer

Mumps

Answer

Varicella

NEET-PG 2023 — Pediatrics